Dr Pratibha Singh WASH in Institutions specialist

WASH in Health Care Settings (COVID -19)

Experiences from Field, India

Contents

1. Madhya Pradesh: WASH & IPC in Healthcare facilities in context of COVID 19 pandemic

2. Odisha- Malkangiri district: Ensuring better Cleaning & Disinfection, CHC, Korukunda, Malkangiri

3. West Bengal: WASH in healthcare centers, effective AV tools for capacity building of Health Care staff, West Bengal

4. Some key learnings

1- Madhya Pradesh: WASH & IPC in Healthcare Facilities in context

of COVID 19 pandemic

State

Geographical Area: 308,000 sq.km, Population: 72.62 million (Census 2011) Population density : 236/ sq. kms (Census

2011) Literacy: 69.32% (Census 2011) Districts: 52

MP: healthcare system at the onset of COVID-19 pandemic

Key Challenges:

1. 5465 cases of COVID positive in 61 days in MP, spike

of 3-5% per day (as on 20th May 2020)

2. Limited preparedness of facilities as per Infection

Prevention Protocols

3. Lack of infrastructure, supply & capacities of health

care functionaries on IPC

4. Limited availability of PPE Kits

5. Movement restrictions due to COVID 19 pandemic

led to cancellation of all in person trainings

MP: COVID-19 pandemic response

STEP 1: Support State health mission in identificationof COVID hospitals & facilities

STEP 2: Development of IPC plan for Health Facilities(25) comprising of:

Communication package with IPC Videos/ audios

Online capacity building module for Doctors andFLWs, Sanitation workers

Capacity building of health care functionaries onIPC protocols

Development of IPC related supply plans(consumables, BMWM/ Disinfection related equipment's,

PPE) with instructions to ensure supply

MP: COVID 19 pandemic response

Step 3- Joint Assessment of Health-WASH preparedness in HCFs

Gaps identification to inform facility improvement plan covering water, sanitation, IPC, including BMWM

Capacity building of Quality assessors, nodal officers for assessment and planning for IPC

Step 4- Technical interventions:

Ready reckoners on toilet maintenance,

Installation of COVID sensitive ( No/Low hand touch/foot operated) HWWS units,

Water quality mgt.

Sterilization and disinfection for surface, equipment’s, linen, transport systems

MP: Key Results from COVID 19 pandemic response

1. Online trainings on IPC in context of COVID- 19: 3500 HCF

functionaries, 2000 ASHAs, 1500 sanitation workers.

2. 25 Facilities assessed for COVID preparedness: improvement plans developed followed by resource mobilization.

3. WASH supplies mobilized: Over 150,000 PPE+Masks, 100,000

sanitizers

4. Weekly meetings for review of quality assurance for addressing the issues through support and coordination

5. Improved implementation of WASH and IPC protocols

6. Improved bio medical waste management through closer monitoring and improvement in connectivity with CTF

Orientation of Public health engineering dept (PHED) on prevention of COVID 19 pandemic

• Orientation of 110 State PHED functionaries of all levels including housekeeping staff

• Infection prevention & control in work places, communities , families

2- Odisha: Ensuring WASH for COVID 19 responsiveness Community health center, Korukunda, Malkangiri

Malkangiri District:

Geographical Area: 5,791 sq.km

Population: 613,192 (Census 2011)

Literacy Rate: 48.5% (Census 2011)

Sub districts: 7

Civil strife affected district

Ensuring better –WASH for responding to COVID19 Pandemic

UNICEF’s support

Capacity building/ training on WASH forCOVID preparedness

Facility improvement plans (FiPs)prepared for WASH

Supportive supervision (WASH, IPC)through follow-up visits duringimplementation of FiPs

During supervision: staff orientation/practical learning sessions werefacilitated

Elements of response at facility level

WASH Infrastructural improvements for toilets, handwashing, drinking water

Ensuring safe drinking water

Cleaning of toilets & floors (Critical, general)

Surfaces Disinfection

Efficient mgt. of hospital waste, hand hygiene, laundry and personal etiquettes

Ensuring availability of consumables like soaps, cleaning and disinfecting material

Facility improvement planning based on gaps assessed

Duty roster for services regularly updated and monitored

Key stakeholders: Healthcare professionals/front line worker (clinical, paramedical,cleaning staff)

Facility: Community Health Centre, Korukunda, Malkangiri, Odisha Care of suspect, referral services for COVID Hospital/COVID Health Centre

Context

This health carefacility was upgradedas COVID 19 facility

Referral service forCOVID suspect-Isolation ward createdduring this COVID19pandemic

16 bedded

60 OPD/ Day

Cleanliness &sanitation services (4cleaning staff)

3- Hand Hygiene

Elbow taps (LR, OT, lab, Dressing)

Handwash facility- entrance (COVID 19) – patient/ visitors

Sensitization on MoHFW advisory -frequency, soap/alcohol based hand rub, moments

Practice standard procedure (staff)

• Monitoring Practice of Hand hygiene by patients, visitors and service providers

2- Sanitation & environment cleaning services 1- Quality Water Services

24*7 availability of adequate, safe water

Water tanks- regular cleaning with records

Disinfection & Chlorination

Periodic quality testing(biological, chemical) & reports

RO water filters -2 for patients

Repair work to ensure adequate toilets with runningwater

Toilets linked to fly proofed septic tanks

Cleaning staff oriented about PPE donning & doffing

Duty roster for janitorial staff

Frequent cleaning of toilets, monitored twice a day

• Record of consumables maintained for timelyreplenishment (disinfectant, brush, bucket, mugs etc.)

Separate- cleaning materials (toilets, general & critical)

Three bucket system implemented for mopping

Cleaning at OT & Labour room (dedicated cleaning staff)

Wet mopping (after every procedure & frequent interval)

No broom use

Follow up of cleaning protocols (Isolation ward etc)

Ensuring better –WASH for responding to COVID19 Pandemic

5- Waste Mgt.

Ensure supply of separate color coded bins, puncture proof container(white)

PPE access: Cleaning worker, waste mgt. (collection, disposal)

1 dedicated cleaning staff for BMW disposal

Segregation (BMW guideline)

Needle sharps container treat. disposal at sharp pit

Improved BMW Mgt.

4- Localized ETP

Attached to WASH basin (lab)

Treatment of slide, equipment's, hand wash

Interconnected to drainage to prevent exposure to open surrounding- soak pit

• Reduce chances ofContamination infectiontransmission

Key intervention for effective COVID-19 response

‘There is regular check of the cleaning, autoclaving, changing of linen, cleaning of surface and collection of SWABs from

different source points to examine the spread of virus in the facility”. Block Programme Manager

7- Social Distancing & Respiratory Etiquettes

Screening-adequate distance

Beds (1 - 2 meter distance)

Individual masks mandatory

Thorough screening of suspected cases (travel, initial symptoms)

Isolation room (6 beds), referral services to COVID hospital.

6- Infection control

Ensure all staff have access to Infection control policy & protocols

Cleanliness & infection control mgt. -through committee

Cleanliness and disinfection measures like microbial surveillance established under guidance of district microbiologist

3- WASH in HCF IEC (AV Aids), West Bengal

Title Key contents (including processes) Uses in WB

WASH in HF AV Training Module (Link)

Language: English & Bengali

(Duration 55 minutes)

1. Basics WASH Service in Health Care Facilities - link to health, economic impacts, quality services, Clint satisfaction,

2. Water services (point of use, source to end user monitoring, reducing contamination- sanitary surveillance, quality, disinfection of storage, waste water drainage)

3. Sanitation services (accessible user friendly features, privacy, safe technology, MHM facility, monitoring frequent cleaning )

4. Infection Prevention & Control (PPE Use, decontamination, disinfection, sterilisation (autoclaving), monitoring checklists,)

5. Hand Hygiene (WASH facility, Elbow Taps, soap/ solution , hand sanitizers, step, key moments, IEC)

6. BMW Mgt. (segregation, PPE use, collection, disposal – BMW, general waste, spill mgt.- blood, IEC, solid )

7. Support services (Linen mgt., Kitchen Mgt.)

8. Env. cleaning (critical areas, PPE Use, 3 bucket system, mopping surface, disinfection of high touch area, chlorine solution, precautions)

9. IEC Displays

UNICEF’s supported– “WASH in HCF AV Training Module ”– has been a helpful tool for capacity building of Health care professional. This is being screened across healthcare facilities in state during COVIFD-19 Pandemic

Key learnings based on field – experiences

1. Challenges posed by COVID 19 can be converted in opportunities for reinforcing WASH & Infection prevention, control behaviours, improvement in services, restructure health service provision and infrastructural adjustments.

2. Capacity Building of all categories of health care professionals (key processes, protocols,) is critical – online technology/ app.

3. Ensuring supplies like PPE, Equipment’s, soaps, sanitizers, disinfectants etc become an integral part of WASH facility improvement plans

4. Effective local language IEC, BCC, AV Tools/ support can facilitate skill transfer at a scale

5. Facility based gap assessment, preparedness & improvement plan, action, supportive supervision- must for sustaining effective WASH, IPC system

6. COVID-19 has helped in enforcing WASH IPC measures- as a new normal including hand hygiene, respiratory etiquettes- using mask, maintaining safe distance- adopted by Heath system & at community level

7. Coordinated team effort of government, community & development partners is critical for COVID response

For more Information, please contact

Pratibha Singh, Ph.D

WASH in Institutions Specialist - UNICEF India

Direct: +91-011- 24690401

Ext: 11107 | prsingh@unicef.org

United Nations Children’s Fund

India Country Office, 73, KK Birla marg,

Lodi Estate, New Delhi, India 110003

Follow us on Facebook, Twitter, Instagram and at www.unicef.in

To support UNICEF donate now www.unicef.in/donate